While the number of residency spots is fixed now, with the potential new influx of 30+ million new patients to our health care system, the need for primary care specialists will grow. The capitation models being proposed ("Accountable Care Organizations," "medical homes," bundled payments, etc.) for physician reimbursement are likely to become the norm.

Although I do not want to sound a doomsday alarm, as doctors increasingly become employees to hospital systems and primary care continues on its path to commoditization, the ability for young doctors to bargain for higher salaries will be difficult because the supply of foreign medical graduates willing to work for relatively lower salaries and fill the gaps seems virtually limitless.

Having seen what outsourced labor from India has done to salaries in IT, it is not a too large a leap to see the same happening to the medical profession, with plenty of willing Indians and Pakastanis willing to work for a fraction of what doctors here make. If medicine becomes institutionalized and run by administrators hiring docs to work for salary, it will only be a matter of time before they start whittling down the salaries of specialists. The only hope is to do what some specialties manage to do, which is limit the number of residency slots so to create a constant shortage of their particular specialty (see dermatology and orthopedics). We are probably training too many cardiologists presently, given what seems to be less need for angiography and stenting, which may be why the goverment feels it can pick on cardiology services. It is called the law of supply and demand and the medical profession will not remain immune to this phenomena. But the good news is that it may decrease our health care costs in the long run. The question you have posed in the past is will it cause a decrease in quality? That remains to be seen.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.